Anatomy and Digital Rectal Examination of the Prostate Gland

The prostate gland is commonly examined through a digital rectal examination, where a gloved index finger is inserted through the anus until it reaches the rectum. The anterior wall of the rectum is then palpated to examine the size and shape of the prostate gland, which lies deep to it. The sigmoid colon, which is proximal to the recto-sigmoid junction, cannot be palpated through this method and requires a sigmoidoscopy or colonoscopy. The urinary bladder sits superior to the prostate and is surrounded by a prostatic capsule. The anus, which is the most distal part of the gastrointestinal tract, does not allow palpation of the prostate gland. The caecum, which is an outpouching of the ascending colon, is anatomically distant from the prostate gland.

While patients assigned male at birth who are undergoing treatment with oestradiol, GNRH analogs, finasteride or cyproterone may experience a decrease or cessation in sperm production, it is not a reliable method of contraception. Therefore, it is important to advise the use of condoms as a suitable option for contraception. It is incorrect to suggest that a vasectomy is the only option, as condoms are also a viable choice. Additionally, recommending that the patient’s partner use hormonal contraception is not appropriate, as advice should be given directly to the patient.

Contraceptive and Sexual Health Guidance for Transgender and Non-Binary Individuals

The Faculty of Sexual & Reproductive Healthcare has released guidance on contraceptive choices and sexual health for transgender and non-binary individuals. The guidance emphasizes the importance of sensitive communication and offering options that consider personal preferences, co-morbidities, and current medications or therapies.

For individuals engaging in vaginal sex where there may be a risk of pregnancy and/or sexually transmitted infections, condoms and dental dams are recommended. Cervical screening and human papillomavirus vaccinations should also be offered to sexually active individuals with a uterus. Those engaging in anal sex and rimming should be advised of the risk of hepatitis A & B and offered vaccinations. Individuals at risk of HIV transmission should be advised of the availability of pre-exposure prophylaxis and post-exposure prophylaxis as required.

For patients seeking permanent contraception, a fallopian tube occlusion or a vasectomy may be the most appropriate solution and neither would be affected by hormonal therapy. Testosterone therapy does not provide protection against pregnancy, and oestrogen-containing regimes are not recommended in patients undergoing testosterone therapy. Progesterone-only contraceptives are considered safe, and the intrauterine system and injections may also suspend menstruation. Non-hormonal intrauterine devices do not interact with hormonal regimes but can exacerbate menstrual bleeding.

In patients assigned male at birth, there may be a reduction or cessation of sperm production with certain therapies, but the variability of effects means they cannot be relied upon as a method of contraception. Condoms should be recommended in those patients engaging in vaginal sex wishing to avoid the risk of pregnancy. Emergency contraception may be required in patients assigned female at birth following unprotected vaginal intercourse, and either of the available oral emergency contraceptive options may be considered. The non-hormonal intrauterine device may also be an option, but it may have unacceptable side effects in some patients.

Overall, the guidance stresses the importance of individualized care and communication in contraceptive and sexual health decisions for transgender and non-binary individuals.

Imaging Tests for Urological Conditions

Non-contrast computed tomography (CT) KUB is recommended by the European Urology Association as a follow-up to initial ultrasound assessment for diagnosing stones, with a 99% identification rate. Micturating cystourethrogram is commonly used in children to diagnose vesicoureteral reflux. Magnetic resonance imaging (MRI) KUB is not beneficial for renal stone patients due to its high cost. Plain radiography KUB may be useful in monitoring patients with a radio-opaque calculus. Intravenous urography (IVU) is less superior to non-contrast CT scan due to the need for contrast medium injection and increased radiation dosage to the patient.

Interpreting Urine and Blood Tests for Renal Colic

Renal colic is a common condition that can cause severe pain in the back and abdomen. When evaluating a patient with suspected renal colic, several tests may be ordered to help diagnose the condition and determine the appropriate treatment. Here are some key points to keep in mind when interpreting urine and blood tests for renal colic:

– Microscopic haematuria with normal nitrites and leukocytes is a common finding in patients with renal colic and/or stones. This suggests that there is blood in the urine, but no signs of infection.
– Positive leukocytes or nitrites on a urine dipstick would be suggestive of a urinary tract infection and would not be consistent with a diagnosis of renal stones.
– A raised serum creatinine can occur with severe renal stones where there is urethral obstruction and subsequent hydronephrosis. This would be a urological emergency and the patient would likely require urgent stenting to allow passage of urine.
– A raised serum white cell count would be more consistent with an infection as the cause of the patient’s pain, making this a less appropriate answer.

In summary, when evaluating a patient with suspected renal colic, it is important to consider the results of urine and blood tests in conjunction with other clinical findings to make an accurate diagnosis and determine the appropriate treatment.

Testicular Torsion: Symptoms, Causes, and Diagnosis

Testicular torsion is a medical emergency that requires immediate surgical intervention. It is characterized by excruciating pain and tenderness in one testicle, which worsens when the testicle is raised. This condition typically affects young teenagers and is caused by an anatomical variant that allows the spermatic cord to wind around itself and cut off blood flow to the testicle. If left untreated for more than 4-6 hours, testicular necrosis can occur.

While orchitis and epididymitis can also cause testicular pain, they are much milder and can be differentiated from testicular torsion by the response to raising the testicle. MRI and X-ray are not helpful in diagnosing this condition, and ultrasound should not delay surgical intervention. Routine blood tests, such as CRP and WCC, may be performed, but surgery should not be delayed while awaiting results.

In summary, testicular torsion is a serious condition that requires prompt diagnosis and surgical intervention to prevent testicular necrosis.

Haematospermia, or blood in semen, is usually not a cause for concern in men under 40 years old. The most common causes are trauma, urinary tract infection (especially prostatitis), and sexually transmitted infection. However, it is important to rule out cancer through appropriate physical examination. If the symptom persists for over a month or there are more than three episodes, referral is recommended, especially for men over 40 years old. While reassurance is appropriate, patients should be encouraged to seek medical attention if the problem persists. Antibiotics may be prescribed if a urinary tract infection is suspected, but this is unlikely in cases with normal urinalysis. Urgent referral is necessary for men with signs and symptoms suggestive of prostate or urological malignancies, or if the underlying cause of haematospermia may be cysts or calculi of the prostate or seminal vesicles.

Medical Imaging Recommendations for Suspected Left Renal Malignancy

Introduction:
When a patient presents with a left-sided varicocele, it is important to consider the possibility of an underlying left renal malignancy. In this scenario, we will discuss the appropriate medical imaging recommendations for this suspected condition.

Ultrasound of the Kidneys, Ureters, and Bladder:
A varicocele is a dilation of the pampiniform plexus of the spermatic cord, which is dependent on the spermatic vein. In some cases, a left-sided varicocele can be associated with a left renal malignancy. This occurs when a large left renal tumor compresses or invades the left renal vein, causing an obstruction to venous return and resulting in a varicocele. Therefore, an ultrasound of the kidneys is recommended to assess for any potential malignancy.

Ultrasound of the Liver:
In this scenario, an ultrasound of the kidneys would be more useful than an ultrasound of the liver, as renal malignancy is suspected.

Ultrasound of the Left Groin:
Signs and symptoms of an inguinal hernia include a bulge in the area on either side of the pubic bone, which becomes more obvious when the patient is upright, especially when coughing or straining. However, there are no signs of hernias on clinical examination in this case.

Magnetic Resonance Imaging (MRI) of the Whole Spine:
MRI of the whole spine is recommended in cases of potential cord compression. However, this is not clinically suspected in this scenario.

Reassure:
If a left-sided varicocele does not drain when lying supine, it should be referred for ultrasound to rule out underlying malignancy. The new onset of the varicocele makes this more likely and therefore should be further investigated.

Understanding the Arteries Involved in Testicular Torsion

Testicular torsion is a condition that causes extreme pain in the groin due to the rotation of the testicle within the scrotum, which occludes flow through the testicular artery. This condition is common in male teenagers during exercise and requires immediate medical attention. In this article, we will discuss the arteries involved in testicular torsion and their functions.

The testicular artery (both left and right) arises from the aorta at the level of L2. Torsion can be diagnosed through colour Doppler ultrasound of the testicle, which shows decreased blood flow. Surgery is required within 6 hours of onset of symptoms to re-establish blood flow and prevent recurrent torsion (orchidopexy). If >6 hours elapse, there is an increased risk for permanent ischaemic damage.

The right and left renal arteries provide branches to the adrenal gland, not the testicles. Both the left and right renal arteries arise from the aorta at the level of L1/2. The internal iliac artery gives off branches to the perineum, but not the testicles. The internal iliac artery branches from the common iliac artery at the level of L5/S1. The external iliac artery gives off the inferior epigastric artery and becomes the femoral artery when it crosses deep to the inguinal ligament. The external iliac artery bifurcates from the common iliac artery at the level of L5/S1.

In conclusion, understanding the arteries involved in testicular torsion is crucial for timely diagnosis and treatment. The testicular artery arising from the aorta at the level of L2 is the primary artery involved in this condition, and surgery within 6 hours of onset of symptoms is necessary to prevent permanent damage.

Types of Kidney Stones and Their Causes

Kidney stones are hard deposits that form in the kidneys and can cause severe pain when they pass through the urinary tract. There are different types of kidney stones, each with their own causes and treatment options.

Calcium Oxalate Stones
Increased urinary oxalate can be genetic, idiopathic, or enteric. Calcium citrate supplementation is the preferred therapy to reduce stone formation. Pain relief and infection prevention are important during the acute period of renal colic. Lithotripsy can be used to break up larger stones.

Uric Acid Stones
Uric acid stones are not visible on X-rays.

Cystine Stones
Cystine stones are also not visible on X-rays.

Calcium Carbonate Stones
These stones are linked to high levels of calcium in the body, either from diet or conditions like hyperparathyroidism.

Magnesium Carbonate Stones
Also known as struvite stones, these are made from magnesium, ammonia, and phosphate and are associated with urinary tract infections.

Understanding the different types of kidney stones and their causes can help with prevention and treatment.

Understanding the Risk Factors and Symptoms of Testicular Cancer

Testicular cancer is a serious condition that can have life-altering consequences if not detected and treated early. One of the main risk factors for this type of cancer is a history of undescended testes, which increases the risk significantly. Additionally, men with a high body mass index may have a lower risk of developing testicular cancer.

It’s important to note that the presence or absence of tenderness in the testicles does not necessarily indicate the presence of cancer. However, any man who notices a lump or mass in the body of the testicle should seek urgent medical attention to rule out the possibility of cancer.

In terms of metastasis, testicular cancer commonly spreads to the para-aortic lymph nodes rather than the inguinal nodes. By understanding these risk factors and symptoms, men can take proactive steps to protect their health and detect any potential issues early on.

Understanding the Risk Factors and Symptoms of Testicular Cancer